The 3 GOP Senators Who Could Stop Obamacare Repeal

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President Obama and GOP Vice president-elect Mike Pence staged dueling appearances on Capitol Hill on Wednesday morning with two very different missions:

With less than three weeks left in his administration, Obama sought to rally the Democrats to try to salvage key elements of the Affordable Care Act. Meanwhile, Pence sought to stiffen the Republican majority’s resolve to repeal a national health insurance program that has extended coverage to more than 20 million Americans.

The Republicans, for sure, are holding most of the high cards in this critically important political poker game, with GOP majorities in the House and the Senate and President-elect Donald Trump, an arch foe of Obamacare, about to succeed Obama in the White House. And the Senate wasted little time yesterday, during the opening day of the new Congress, in unveiling a skeletal budget bill that will be used as the vehicle for dismantling much of Obamacare in the coming weeks.

But as the Republicans appear on the verge of realizing a six-year-old goal of repealing one of Obama’s crowning achievements, the enormity of their action is sinking in. And at least a few GOP lawmakers are having second thoughts about the wisdom of repealing the Affordable Care Act before having a suitable replacement in hand.

Even without Republican opposition, Obamacare has had challenges from the outset. The millions of dollars spent on Healthcare.gov that took more than a year to function properly was the first blow. The second was Obama’s broken promises: You can keep your doctor and your health plan, neither of which was true.

But the greatest setback was the lack of signups by young people who were supposed to pay for the chronically ill and aged. That led to higher premiums and outrageously high deductibles for people who in some cases could not afford to go to a doctor even if their premiums were subsidized. Without the young people buttressing the old, insurers lost money, and some decided to bail out of the program altogether.

For consumers who depended on Aetna and United, this was yet another nightmare. But through it all, 20 million people had access to healthcare – many for the first time in their lives.

Trump, House Speaker Paul Ryan (R-WI), Rep Tom Price (R-GA), Trump’s designated health and human services secretary and others bravely insist the key elements of a market-oriented GOP replacement plan are on the drawing board. Yet with many Americans just waking up to the fact they could lose their Obamacare or expanded Medicaid coverage and a growing uproar among insurers, hospital administrators, doctors and consumer advocates worried about the consequences of the GOP’s planned actions, some Republicans are raising a cautionary flag.

At least three Republican senators – Susan Collins of Maine, Rand Paul of Kentucky and Bill Cassidy of Louisiana – have signaled to their leaders that it would be a big mistake to plunge ahead with repealing Obamacare without a replacement plan waiting in the wings, as the Morning Consult reported today.

Obamacare provides tax subsidies to low and moderate income families and individuals to purchase private health insurance on government-run exchanges. It also requires uninsured Americans to purchase coverage, imposes other mandates on insurers, the pharmaceutical industry, hospitals and the medical device industry, and it levies taxes to help finance operating costs.

Because of the special budget “reconciliation” rules being followed to sidestep Democratic opposition, the Republicans can repeal some but not all of Obamacare. Moreover, Trump has said he wants to preserve some provisions of the current law, including a ban on insurers discriminating against consumers who have chronic illnesses and allowing parents to keep their children on their health insurance plans until they turn 26.

The three GOP senators cited concerns about adverse market reaction to a swift, partial repeal of Obamacare without an alternative to replace it. Even if the repeal doesn’t formally take effect for two or three years, the lawmakers worry about a continued exodus of major insurance companies from Obamacare and rising premiums during the transition.

Cassidy on Tuesday tweeted that “Many are worried about losing insurance coverage.” Collins told the Portland Press Herald late last month that she didn’t “want to see people drop through the cracks.” And on Monday, Paul warned in an op-ed in Rare that unless they moved quickly to replace Obamacare with a fully-developed plan that works, the Republicans could end up being blamed for the continued deterioration of the program.

“We should repeal Obamacare, but partial repeal will only accelerate the current chaos and may eventually lead to calls for a taxpayer bailout of insurance companies,” he wrote.

Paul added, “Partial repeal of Obamacare will likely win the day, but when the insurance companies come to Washington crying for a bailout don’t say that no one warned of this preventable disaster.”

Although none of the three Republicans are threatening to vote against a repeal budget package, they all sit on committees that will work directly on the repeal effort and the subsequent replacement legislation. What’s more, with Republicans holding a relatively narrow 52 to 48 seat majority in the Senate, it would only take three defections to stop the repeal effort in its tracks.

A number of studies by the Congressional Budget Office and independent research organizations have warned that a partial repeal of Obamacare would result in millions of Americans losing their health insurance and Medicaid coverage or having to settle for considerably less coverage.

During a press conference after meeting with House Republicans, Pence repeatedly sought to assure lawmakers that the incoming Trump administration would do nothing to “work a hardship” on the American people.

“We’re talking about people’s lives, we’re talking about families,” Pence said. “But we are also talking about a policy [under Obama] that has been a failure virtually since its inception.”

“We intend over the course of the coming days and weeks to be speaking directly to the American people about that failure, but about a better future we can have in healthcare,” he added. “A future that is built not on growing government, not on mandates, not on taxes, but rather a future that is built on giving the American people more choices in health care, allowing the power of the free marketplace to flow in.”

But following the Democrats closed-door meeting with Obama, newly ensconced Senate Democratic Leader Chuck Schumer of New York mocked Trump and the Republican leadership, arguing that they are trapped in their commitment to repeal Obamacare, but with no consensus on how to replace it.

“My Republican colleagues don’t quite know what to do,” Schumer told reporters. “They’re like the dog who caught the bus. They can repeal, but they have nothing to put in its place. And that means so many good things go away.”

Washington Editor and D.C. Bureau Chief Eric Pianin is a veteran journalist who has covered the federal government, congressional budget and tax issues, and national politics. He spent over 25 years at The Washington Post.